Magnetic Susceptibility from Quantitative Susceptibility Mapping Can Differentiate New Enhancing from Nonenhancing Multiple Sclerosis Lesions without Gadolinium Injection

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In 54 patients, new T2-weighted lesions were evaluated for enhancement on conventional T1-weighted imaging with gadolinium, and their susceptibility values were measured on quantitative susceptibility mapping. Eighty-six of 133 new lesions that were gadolinium-enhancing had relative susceptibility values significantly lower than those of nonenhancing lesions. Using susceptibility values to discriminate enhancing from nonenhancing lesions showed a sensitivity of 88.4% and specificity of 91.5%, with a cutoff value of 11.2 parts per billion for QSM.

Abstract

Figure 1 from paper
MR images of enhancing and nonenhancing new MS lesions. T1WI+Gd (A), T2WI (B), and QSM (C) in a 44-year-old woman with relapsing-remitting MS. Two enhancing lesions (A and B, arrows) are found in T1WI+Gd. One is shell-enhancing (A, white arrow) and another is nodular-enhancing (A, black arrow). The shell-enhancing lesion appears slightly QSM-hyperintense (C, white box) and the nodular one appears QSM isointense (C, black box). T1WI+Gd (D), T2WI (E), and QSM (F) in a 35-year-old woman with relapsing-remitting MS. Two new nonenhancing lesions (D and E, arrows) are found in T1WI+Gd and T2WI compared with MR imaging 6 months prior. The 2 lesions both appear QSM-hyperintense with bright rims (F, arrows).

BACKGROUND AND PURPOSE

Magnetic susceptibility values of multiple sclerosis lesions increase as they change from gadolinium-enhancing to nonenhancing. Can susceptibility values measured on quantitative susceptibility mapping without gadolinium injection be used to identify the status of lesion enhancement in surveillance MR imaging used to monitor patients with MS?

MATERIALS AND METHODS

In patients who had prior MR imaging and quantitative susceptibility mapping in a current MR imaging, new T2-weighted lesions were evaluated for enhancement on conventional T1-weighted imaging with gadolinium, and their susceptibility values were measured on quantitative susceptibility mapping. Receiver operating characteristic analysis was used to assess the diagnostic accuracy of using quantitative susceptibility mapping in distinguishing new gadolinium-enhancing from new nonenhancing lesions. A generalized estimating equation was used to assess differences in susceptibility values among lesion types.

RESULTS

In 54 patients, we identified 86 of 133 new lesions that were gadolinium-enhancing and had relative susceptibility values significantly lower than those of nonenhancing lesions (β = −17.2; 95% CI, −20.2 to −14.2; P < .0001). Using susceptibility values to discriminate enhancing from nonenhancing lesions, we performed receiver operating characteristic analysis and found that the area under the curve was 0.95 (95% CI, 0.92–0.99). Sensitivity was measured at 88.4%, and specificity, at 91.5%, with a cutoff value of 11.2 parts per billion for quantitative susceptibility mapping–measured susceptibility.

CONCLUSIONS

During routine MR imaging monitoring to detect new MS lesion activity, quantitative susceptibility mapping can be used without gadolinium injection for accurate identification of the BBB leakage status in new T2WI lesions.

 

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Magnetic Susceptibility from Quantitative Susceptibility Mapping Can Differentiate New Enhancing from Nonenhancing Multiple Sclerosis Lesions without Gadolinium Injection
Jeffrey Ross
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